Fed’s Antismoking Efforts Get Passing Grade

But Most States Continue to 'Fail Miserably,' Spokesman Says

Medically Reviewed by Laura J. Martin, MD on January 19, 2011
From the WebMD Archives

Jan. 20, 2011 -- Federal efforts to reduce smoking in the United States are being applauded by the American Lung Association, but the group says most states are still doing far too little to help smokers quit and keep nonsmokers from starting.

In its ninth annual State of Tobacco Control report, the American Lung Association (ALA) tracked the progress of national and state tobacco control initiatives during 2010.

The implementation of landmark antismoking legislation and the passage of health care reform last spring were hailed as major steps forward in the national effort to lower smoking rates.

Federal Efforts Get Passing Grade

As a result, federal officials received a passing grade from the group, while most states failed to make significant progress.

“President Obama and the 111th Congress enacted the strongest tobacco control policies in American history, but we still have a long way to go,” ALA President Charles D. Connor said at a news briefing.

He added that most states are “failing miserably” in their tobacco control efforts.

“Despite collecting millions of dollars and in some cases billions in tobacco settlement money and excise taxes, most states are investing only pennies of those dollars to help smokers quit and keep kids from starting,” Connor said.

The report noted that tobacco prevention and smoking cessation have emerged as the major initiatives in the federal government’s antismoking initiatives.

The Tobacco Control Act, signed into law in 2009, gave the FDA the authority to regulate tobacco products. Key provisions include strengthening restrictions on the sale and marketing of tobacco products to children and teens and the removal of misleading terms like “light,” “mild,” and “low-tar” from cigarette labeling.

And the sweeping health care reform law mandates coverage of tobacco cessation treatments by most private health care insurers. It also requires that the states offer these treatments to low-income pregnant women who receive Medicaid.

But Much More Could Be Done

These changes raised the federal government’s grade for smoking cessation coverage from an F to a C. But the failure to offer such coverage to all Medicaid recipients will end up costing taxpayers money, the group claims.

“Medicaid recipients smoke at rates that are almost 60% higher than the general population, and the cost of not helping these smokers quit is sky high,” ALA Vice President for National Policy and Advocacy Paul Billings said Wednesday.

Nationwide, about 36% of low-income Americans on Medicaid smoke, compared to about 22% of adults nationwide. Billings said about $1 of every $10 spent on health care under the federal program can be attributed to tobacco-related illness.

“Millions of Americans will be able to receive needed help to quit smoking under the Affordable Care Act, but many of the people who need the help the most will slip through the cracks.”

Eight States Get All F's

The state-by-state report card included grades in four key areas: coverage of tobacco control programs at funding levels recommended by the CDC, coverage of smoking cessation treatments, passage of smoke-free air laws, and cigarette tax rates.

Although no state received straight A’s, Arkansas, Hawaii, Maine, Montana, and Vermont had the best scores overall.

Eight states received all F’s: Alabama, Kentucky, Mississippi, Missouri, North Carolina, South Carolina, Virginia, and West Virginia.

Other state-by-state highlights:

  • The three states that made the most progress in 2010 were Hawaii, which increased funding for tobacco prevention programs; Utah, which raised state cigarette taxes by $1; and Montana, which extended smoking cessation coverage to state employees.
  • 40 states and the District of Columbia received F’s for failing to fund tobacco control programs at 50% or more of the level recommended by the CDC.
  • Just two states, North Dakota and Alaska, fund such programs at 80% of the level recommended by the CDC.
  • The passage of state smoke-free air laws has slowed to a virtual halt. About half the states now have comprehensive laws aimed at protecting the public and workers from smoke. Only one new state, Kansas, passed such a law in 2010.

The report, along with state-by-state scores and analysis, can be found on the ALA’s web site,

Report: ‘Industry Deception Continues’

The report was highly critical of the tobacco industry, charging that manufacturers continue to deceive smokers and look for ways to circumvent new laws restricting cigarette sales and marketing.

Among the specific charges:

  • Now that cigarette packaging can no longer use descriptors like “light,” “mild,” and “low-tar,” manufacturers have begun to color-code their packaging so that consumers will associate a specific color with the banned descriptor.
  • The report specifically cited Marlboro Lights, now sold as Marlboro Gold, which are the top-selling “light” cigarettes in the U.S. Shortly before the ban went into effect, Marlboro manufacturer Altria ran ads telling customers “Your Marlboro Lights package is changing, but your cigarette stays the same.”
  • Tobacco companies have introduced new smokeless tobacco products bearing the same name brands as their most popular cigarettes. They have increased the marketing budgets for these products. According to the CDC, the use of smokeless tobacco products increased by 36% among high school boys between 2003 and 2009.

Conner called the new smokeless tobacco products a blatant example of how the industry is attempting to get young people addicted.

“The industry found new ways in 2010 to market its products and target kids so it could make up for older customers who either died or successfully quit,” he said.

State-by-State Smoking Cessation Coverage Grades

No state provides comprehensive coverage for smoking cessation, so none received an A on the report card.

States with a B Grade:


States with a C Grade:



New Mexico

North Dakota


States with a D Grade:





Rhode Island



District of Columbia

States with an F Grade:
























New Hampshire

New Jersey

New York

North Carolina



South Carolina

South Dakota





West Virginia


Show Sources


American Lung Association: State of Tobacco Control 2010, Jan. 19, 2011.

Charles D. Connor, president and CEO, American Lung Association.

Paul Billings, vice president, National Policy and Advocacy, American Lung Association.

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